EP2677939B1 - Bloc de réduction d'essai spécifique au patient - Google Patents

Bloc de réduction d'essai spécifique au patient Download PDF

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Publication number
EP2677939B1
EP2677939B1 EP12705125.8A EP12705125A EP2677939B1 EP 2677939 B1 EP2677939 B1 EP 2677939B1 EP 12705125 A EP12705125 A EP 12705125A EP 2677939 B1 EP2677939 B1 EP 2677939B1
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EP
European Patent Office
Prior art keywords
block
distal
dorsal
femur
patient
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Application number
EP12705125.8A
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German (de)
English (en)
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EP2677939A1 (fr
Inventor
Christoph Weber
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Microport Orthopedics Inc
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Microport Orthopedics Inc
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Publication of EP2677939A1 publication Critical patent/EP2677939A1/fr
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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4684—Trial or dummy prostheses
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/14—Surgical saws ; Accessories therefor
    • A61B17/15—Guides therefor
    • A61B17/154—Guides therefor for preparing bone for knee prosthesis
    • A61B17/155—Cutting femur
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/14—Surgical saws ; Accessories therefor
    • A61B17/15—Guides therefor
    • A61B17/154—Guides therefor for preparing bone for knee prosthesis
    • A61B17/157—Cutting tibia
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
    • A61B17/1675—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the knee
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B2017/568—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor produced with shape and dimensions specific for an individual patient
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/38—Joints for elbows or knees
    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B33—ADDITIVE MANUFACTURING TECHNOLOGY
    • B33Y—ADDITIVE MANUFACTURING, i.e. MANUFACTURING OF THREE-DIMENSIONAL [3-D] OBJECTS BY ADDITIVE DEPOSITION, ADDITIVE AGGLOMERATION OR ADDITIVE LAYERING, e.g. BY 3-D PRINTING, STEREOLITHOGRAPHY OR SELECTIVE LASER SINTERING
    • B33Y80/00—Products made by additive manufacturing

Definitions

  • the present invention relates to the field of endoprosthetics, in particular total knee arthroplasty. It relates to a sample reduction block according to claim 1, and to a production method according to claim 14.
  • the primary prostheses that are common today consist of a femoral component and a component attached to the tibia, which, in contrast to the hinge prosthesis, are not connected to one another by artificial mechanical aids.
  • the flexible connection between the two components is made by ligaments and muscles as far as they are in knee arthroplasty, i. preserved during resection and subsequent implantation of the prosthesis.
  • the femur and tibia Before the prosthetic components on the femur or tibia can be fixed by jamming, wedging and / or bone cement, the femur and tibia must be brought into the form suitable for the prosthesis with the help of bone saws and other instruments.
  • the instruments used in general by the manufacturers of the knee prosthesis for this serve primarily to make the necessary corresponding bone cuts on the femur and tibia, the so-called osteotomies with the necessary accuracy in the first place.
  • the femur is finished with bony landmarks. Subsequently, the tibia is resected and finished. Only at the trial reduction with the trial prostheses are the actual ligament ratios visible to the surgeon / surgeon.
  • the tibia is resected first and then the cut blocks are positioned on the femur using bony landmarks, but considering the ligament conditions (femur rotation). This means that the final positioning of the femoral prosthesis is not always the bony landmarks, z. As Epycondylarachse corresponds, but can be achieved, however, that it is implanted absolutely balanced.
  • the cutting blocks are positioned via extra- or intramedullary alignment instruments, which are aligned using bone landmarks. Even with the computer-navigated surgical technique (CAS), the cut blocks are aligned using the same bone landmarks.
  • CAS computer-navigated surgical technique
  • the advantage is that you have the landmarks, Leg axes, etc. and the cut blocks visualized on the screen in front of him.
  • the cutting blocks can now be fitted with sensors that are detected by a camera without additional instruments.
  • a computed tomography (CT) or nuclear spin (MRI) image is taken prior to surgery to produce an accurate three-dimensional (3D) image and to grasp the leg axes.
  • the 3D data is sent to the prosthesis manufacturer, who can plan the prosthesis and the corresponding cutting blocks based on the exact 3D model of the defective joint.
  • the doctor can process the finished planning online and then issue his consent to the production of the cutting blocks. It can also specify default parameters, such as axis information, tibial slope, femur rotation, etc.
  • the cut blocks or pin blocks including 3D models of the proximal areas of the tibia and the distal end of the femur.
  • the belt ratios can not be taken into account in the planning. Intraoperatively, the band ratios can only be considered as described above under "Femur first" technique.
  • a femoral implant is attached to or replaced at the distal end of the femur, and a tibial implant having a base plate for attachment to the tibia and an articular surface replaces the proximal end of the tibia.
  • a patella posterior surface replacement can also be used to supply the femoral-patella joint.
  • the surgeon then recites the proximal end of the opposing tibia with the so-called tibial cut to create the surface for receiving the complementary baseplate.
  • the femoral implant and tibial base plate are attached to the respective bone with adhesives or fasteners.
  • the articular surface is attached to the side of the tibial baseplate facing the femoral implant.
  • Patient specific cutting blocks are for example from the WO 2010/099142 and US 2009087276 known.
  • invention with the patient-specific sample reduction block enriches the known surgical technique with patient-specific cut blocks in that the soft tissue situation, resp. Band tension conditions can be checked intraoperatively and corrected. It allows a surgical procedure with accuracy and accuracy that was previously available only in the bone referenced surgical technique thanks to a patient-specific incision block.
  • the present invention corresponds to both applied philosophies: "Tibia first” and "Femur first”.
  • the reduced duration of surgery not only has a positive effect on the cost of the surgery, but it also significantly reduces the risk of infection for the patient, as the knee must be open much less. Further advantages of the new sample reduction block according to the invention are that fewer instruments have to be used during the operation, thereby reducing the need for training for doctors and surgical staff.
  • the patient-specific trial reduction block according to the present invention actually combines the functionality of a trial reduction, correction and cutting block according to preferred embodiments. He offers correction options even before the first femoral cut. It ensures that the surgeon has the safest, most accurate, fastest and most cost-effective implantation method for a knee endoprosthesis.
  • Femur build-up is included in the block, which is dimensioned to lie the femur in the planned "corrected" end position on the tibia during surgery.
  • the rotational correction of the femur could also be achieved only after the distal femoral cut by eye measurement by rotating the 4in1 block.
  • the surgeon gives the surgeon the possibility of soft tissue, resp. to control the ligament tension and adjust if necessary before working on the femur.
  • the surgeon may, if necessary, make a tape and capsule release to balance the joint. He can also make a bending and Elfenspaltstreet and check the Retrobeinachse.
  • This is directly with the help of the sample reduction block, and possibly with the help of spacers (gap gauge) or with a standard knee analyzer resp. Pressure sensors possible.
  • the latter can be integrated into the sample reduction block according to the invention or can be detachably fastened in suitable receiving regions of the sample reduction block according to further embodiments.
  • pin holes are located on the trial reduction block such that they provide well-defined alternative positions for pins in the event of a possible shift in the "joint line” or a varus / valgus correction (for the distal femur cut) or for rotation or for the anterior / posterior (a / p) shift of the femoral component (reference holes for pins for mounting the 4in1 cutting block).
  • the reduction block comprises insertable inserts by means of which the planned or predetermined discrete correction positions of the pin bores can be selected.
  • the correction position of the pin holes can be adjusted as needed on the correction insert.
  • correction pin holes defining the correction positons may be used to make, for example, "joint line” shifts and varus / valgus corrections, or the holes for the pins for a conventional distal cutting block, as desired Correction to set.
  • the distal reference holes for the 4 in 1 block can be drilled through the block in various rotational and a / p positions. Depending on the knee system, it is also possible to change the femoral size (reference holes referenced anteriorly or posteriorly).
  • the tibial cutting block remains unchanged (as offered by various manufacturers)
  • the trial reduction block for the femur is made patient specific. Being patient-specific will not only be
  • the specimen adaptation block is understood to mean specifically fitting a proximal surface of the trial reduction block to the surface of the distal femur portion, or at least substantial landmarks within that portion, but also accurately fitting the trial reduction block with respect to the distal and dorsal femur prosthesis and tibia designs is defined dimensioned.
  • the location and position of the distal and dorsal sidewalls of the trial reduction block are precisely predetermined with respect to the proximal surface of the trial reduction block, or at least with respect to substantial landmark reference areas within that proximal surface.
  • the trial reduction block according to the present invention defines with its distal side wall a distal reference surface, which preferably comes to lie exactly on the tibial cut, respectively on the protective plate on the tibial cut, in the deployed state according to operation planning in the extended knee, ie in the extension state.
  • the distal side wall is dimensioned smaller, so that the distal reference surface does not lie directly on the tibial cut, respectively on the protective plate on the tibial cut, but on an additionally used spacer of known thickness.
  • the block may have convex condyles, medial and lateral.
  • the trial reduction block defines a dorsal reference surface which, in the inserted state according to surgical planning, preferably lies exactly on the tibial cut, ie in the state of flexion, on the tibial cut.
  • the wall thickness can be reduced again and a spacer of defined thickness can be used.
  • the proximal surface of the trial reduction block is manufactured to be patient specific.
  • the distal and dorsal reference surfaces of the associated sidewalls define, measured from the respective sections, the distal or dorsal femoral configuration of the femoral component, as well as the entire tibial structure.
  • the thickness of a tibial cut protection sheet may be taken into account and deducted in dimensioning the sample reduction block.
  • the distal reference surface is arranged such that it defines the joint position in the extended state.
  • the reference surfaces need not be formed by the entire sidewall, but that the actual extent of the planar reference surface may be limited to a smaller area at the intersection of the respective datum axis. In extreme cases, the entire surface may also have a radius. However, preference is given to working with a discrete flat reference surface.
  • the distal and dorsal reference surfaces of the trial reduction block define a common reference angle. According to preferred embodiments, this reference angle corresponds to the flexion angle which is formed by the anatomical femur axis and the anatomical tibial axis in the flexed state in the flexion gap measurement (0 ° / 90 °).
  • a trial repository block for defining at least one incision plane on a femur in total knee arthroplasty comprises at least one patient-specific proximal reference region facing the distal surface of the femur, and a distal side wall defining a distal reference surface which coincides with the tibial cut according to patient-specific surgical planning in extension of the knee joint, and a dorsal sidewall defining a dorsal reference surface which conforms to patient-specific surgical planning for flexion of the knee joint coincides with the tibial cut.
  • the distal and / or the dorsal reference surface are each formed directly from the surface of the respective distal and / or dorsal side wall.
  • the distal and / or the dorsal reference surface are formed by spacers, which are arranged on the respective side walls, wherein the spacers are preferably releasably attachable to the side walls.
  • the sample repository block according to the invention is advantageously characterized in that the anterior block part comprises a cutting guide for a distal femoral cut, which can lead to a tool for creating the distal femoral cut, wherein the cutting guide defines a reference plane for the distal femoral cut, which in such a way to the distal reference plane of the Aligned trial reduction block that these two levels correspond to the extension gap according to the patient-specific operation planning.
  • the dimension of the extension gap is thus directly simulated by the thickness of the distal side wall, or - according to further embodiments - additionally deliberately selected a smaller thickness and set the mass using a spacer (ie, a gap gauge).
  • a spacer ie, a gap gauge
  • spacers has the additional advantage that it is very easy to simulate different inlay thicknesses with different spacer thicknesses. Also, the ratio or difference between the bend and the stretch gap can be measured.
  • the trial repository block according to the invention preferably comprises an anterior and a dorsal block part, which are releasably fastened to one another in a precisely defined position relative to one another.
  • the two-piece design with the removable dorsal block portion has been found to be particularly advantageous in the extension gap and leg axis measurement (HKA axis) as the dorsal portion of the block would affect this measurement by diverting the dorsal capsule and in flexure measurement because of the distal portion of the block would prevent the measurement with patella inserted.
  • the dorsal block portion preferably surrounds the dorsal condyles of the femur for flexure measurement with the patella inserted.
  • the corresponding surface of the dorsal block part is in turn made patient-specific on the basis of the 3D data, which are recorded in any case to determine the size in the operation planning in CT or MRI.
  • the trial reduction block must fit snugly on the articular surface (trochlea) (necessary so that the osteophytes can be removed beforehand and the ligament tensions are not influenced by "diverting") and enclose the outermost points of the distal and dorsal condyles.
  • the distal and dorsal surface is preferably smooth.
  • the dorsal block portion on the dorsal sidewall and the distal block portion on the distal sidewall are preferably provided with recesses for receiving sensors and / or directly with sensors.
  • the sensors are preferably pressure sensors, and more preferably medial and arranged laterally on the respective side wall.
  • the sensors are either integrated directly from the factory, or there are recesses or recordings so that appropriate sensors can be mounted in the clinic on request or if required.
  • distal and posterior surfaces are provided with medial and lateral convex curves (condyles). These condyles are detachably available in different thicknesses to simulate different corrections. (Resection quantity, varus / valgus, femur rotation, inlay thicknesses, femoral sizes). These can also be equipped with sensors. Preferably, the measurement is then performed with medial or lateral spacers to simulate the above corrections.
  • the trial reduction block comprises, in addition to the distal incision, all other femoral incisions.
  • the anterior block part thus additionally has a cutting guide for a second (for example a posterior) femoral cut and / or a third (for example an anterior) femoral cut and / or any further femoral cuts.
  • an anterior side wall is provided with positioning means, most preferably in the form of various correction pin-hole pairs (+ 2mm, + 4mm, 0mm, -2mm, -4mm, 1 ° - 3 ° varus / valgus) around a conventional distal one If necessary, distalise, proximalize, variate or valgate the cut block.
  • positioning means most preferably in the form of various correction pin-hole pairs (+ 2mm, + 4mm, 0mm, -2mm, -4mm, 1 ° - 3 ° varus / valgus
  • various drill holes are present on the distal side wall (1 ° in / out 2 ° in / out 3 ° in / out 5 ° in / out 7 ° / + 2mm, - 2mm), by means of which the rotation and a / p Position of the 4in1 block (a / p incisions, respectively femoral component) can be adjusted.
  • the respective associated boreholes of a pair is preferably in turn arranged one each in the medial and one in the lateral region of the side wall.
  • the block according to the invention may preferably be designed in such a way that it can directly receive cut blocks from conventional instruments, as can be seen for example from US Pat WO 2010/099142 is known.
  • the sample reduction block according to the invention comprises receptacles for extramedullary axis control instruments, as known from the prior art and available on the market.
  • one or more recordings of one or more references for different CAS systems are provided in the block according to the invention.
  • the sample reduction block according to the present invention is preferably made entirely in a rapid prototyping method.
  • At least the patient-specific components, in particular the patient-specific proximal reference region, and preferably the dorsal and distal side walls of the dorsal and anterior block parts, are produced in a rapid prototyping method.
  • Rapid prototyping processes are manufacturing processes in which components are constructed directly from 3D data, preferably layer by layer, from informal or shape-neutral materials.
  • 3D printing processes are currently in question which use plastics, lime powder with an epoxy shell or photopolymers based on acyl, or electron beam melting processes for metals, or fused deposition modeling (FDM) processes for acrylonitrile-butadiene-styrene copolymers ( ABS) or polycarbonate, or laminated object modeling (LOM) processes for paper, plastics, ceramics or aluminum, or laser engineered Net Shaping (LENS) process for metals, or laser cladding for metals or Selective Laser Smelting (SLM) for metals, plastics or ceramics, or Selective Laser Sintering (SLS) for thermoplastics (for example: polycarbonates, polyamides, polyvinyl chloride, metals, ceramics) or Stereolithography (STL or SLA) methods for liquid duromers or elastomers.
  • FDM fused deposition modeling
  • LOM laminated object modeling
  • LENS laser engineered Net Shaping
  • SLM Selective Laser Smelting
  • SLS Selective Laser
  • the present invention realizes the following advantages over already available patient-specific cutting blocks. It does justice to the two operations philosophies "bone referenced” and “soft tissue referenced” by combining the advantages of both techniques. It allows the final result to be assessed according to the patient-specific surgical planning already after the tibial cut and, if necessary, to make the appropriate corrections. In addition, a tape and capsule release can be made before the femur is processed. The ligamentous conditions are the same as with the trial prosthesis or the definitive prosthesis.
  • a 2 ° varus correction for the distal incision on the femur which corresponds exactly to a deviation of the mechanical femoral axis of 2 °, can be directly and accurately effected by the new sample reduction block using the positioning means, for example in the form of pin. Downhole pairs, make.
  • a patient-specific trial restoring block for defining at least one cutting plane on a femur in total knee arthroplasty, it is essential that based on 3D data of the knee being treated, at least one patient-specific proximal reference region placed against the distal surface of the femur F be prepared and a distal sidewall prepared such that it Defines a distal reference surface, which coincides with the tibial cut according to the patient-specific operation planning in the extension of the knee joint.
  • a dorsal side wall is preferably produced in such a way that it defines a dorsal reference surface which, in accordance with the patient-specific surgical planning during the flexion of the knee joint, coincides with the tibial cut.
  • the side walls need not be continuous surface, but at least three support points that lie in the respective reference plane and define them.
  • FIGS. 1a and 1b is a schematic representation of the human leg skeleton in preoperative ( Fig. 1a ) and in the postoperative state with inserted primary total knee prosthesis ( Fig. 1 b) showing, in each case, a left leg with the anatomical axes of tibia aT and femur aF, the HKA axis and the valgus angle ⁇ .
  • FIG. 2a the trial reduction block 1 in the assembled state is shown in a view on the distal side.
  • the trial reduction block 1 is composed of an anterior block part 2 and a dorsal block part 3.
  • the fastening means which hold the two block parts positively and / or non-positively in the intended position, are not shown in the figure.
  • a distal side wall 4 defines a substantially planar distal reference surface 8, which is in accordance with the patient-specific surgical planning in the extension of the knee joint coincides with the tibial cut, respectively comes to rest during the trial reduction on the cut tibial surface or on a protective plate arranged thereon.
  • FIG. 2b is a view of the proximal, patient-specific shaped side of the sample reduction block 1 according to the FIG. 2a shown.
  • the patient-specific design of the proximal side, respectively the proximal reference region 10 of the trial reduction block 1 becomes clear.
  • the proximal portions of the anterior block portion 2 as well as the posterior block portion 3 are exactly adapted to the surface of the patient's femur to be replaced.
  • the patient-specific configuration of the proximal reference regions in the illustrated exemplary embodiment is adapted over the entire area to the previously determined 3D data of the joint region to be replaced so that a highly accurate positioning of the block 1 on the femur / femoral condyle is ensured.
  • the illustrated implant is also customized with respect to the thickness of the distal side wall 4 and the dorsal side wall 5 to the patient, respectively, to the patient-specific surgical planning.
  • the wall thickness 40 of the distal side wall 4 in the exemplary embodiment shown is selected such that the distal reference surface 8 defined by the distal side wall 4 (in conjunction with FIG FIG. 2a ) specifies the desired stretch gap of, for example, 18 mm.
  • the block 1 according to the FIGS. 2a to 2d itself does not include a cutting guide for a distal and possibly further femoral cuts, which can lead to a tool for creating these femoral cuts.
  • it has positioning means in the form of various pin-hole pairs, by means of which holes for receiving pins for positioning a conventional cutting block on the femur can be accurately positioned. From one boring in the medial and one in the lateral region of the side wall 4 is arranged in each of the associated boreholes of a pair for rotational correction in order to achieve a high precision of the defined plane over as large a distance as possible.
  • FIGS. 2a . 2 B and 2d indicated, according to preferred embodiments integrated or integratable sensors 70, which are used for stress measurement in the extension.
  • the sensors, as well as the pin-hole pairs are in the FIGS. 2a-2d not shown in all views.
  • the anterior block part 2 and the posterior block part 3 are shown objected to each other. From the synopsis with the Figure 2c It is clear that, according to preferred embodiments, the relative positioning of the two block parts to each other can be effected not only by positive locking means, as will be shown below, but also by adhesion means such as magnets 12 which are mutually oppositely sunk in the block parts sunk. In the Figure 2d these magnets 12 are indicated by dashed lines.
  • FIG. 3a schematically shows how a two-part sample reduction block 1 'according to an embodiment of the invention
  • the substantially the sample reduction block 1 according to the FIG. 2 corresponds, in use is arranged on a bent knee.
  • a dorsal side wall 5 ', the dorsal block part 3' defines a dorsal reference surface, which in the inserted state according to surgical planning at the bent knee, that is in the illustrated state of flexion exactly on the tibial cut, respectively on the fender 80 on the tibial cut comes to rest.
  • the wall thickness of the dorsal side wall 5 ' is exactly adapted to the patient-specific surgical planning and defines a dorsal reference surface, the the flexion of the knee joint coincides with the tibial cut, respectively, during the trial reduction comes to rest on an apron 80 arranged on the tibial cut.
  • FIG. 3b is the situation according to the FIG. 3a shown in a view of the distal side surfaces of the two block parts 2 'and 3'.
  • the treating surgeon can use the patient-specific trial reduction block 1 directly check the flexion gap, as it was created according to the operation planning. If he finds out during this test that the dimensioning of the flexion gap and / or the intended rotation does not fit the patient-specific soft-tissue situation, he can correct this error with the help of the correction pin drill holes immediately and the holes for the recording of the pins in the Deviating from the surgical planning, attach the femur in such a way that the joint is optimally balanced soft-tissue-referenced in flexion.
  • FIGS. 4a and 4b is the knee joint according to the FIG. 3a and 3b with the help of the anterior block part 2 'made the trial reduction in the extended knee. From the FIG. 4a it is clear that the posterior block part 3 'is removed for checking the operation planning in the extension. Only the anterior block part 2 'is used to make any necessary displacement of the "joint line" or a varus / valgus correction (for the distal femur cut). The anterior block part 2 'rests with its distal side wall 4 directly on the fender 80 on the tibial cut. In the illustrated embodiment, therefore, the distal wall surface of the distal side wall 4 directly forms the distal reference surface.
  • the surgeon determines that the extension gap according to the surgical planning is not optimally adapted to the soft tissue situation of the patient, or that the desired varus and valgus angles are not reached, he may in turn use the correction pin holes arranged in the frontal side wall 7 45, 46 set the holes for the pins taking into account the necessary corrections.
  • FIG. 5a a sample reduction block 100 according to another embodiment of the present invention is shown.
  • the trial reduction block 100 is in turn subdivided into an anterior block part 102 and a posterior block part 103.
  • the distal side wall 104 and the ventral side wall 106 of the anterior block part 102 are each provided with two receiving openings 111, 112, 113 and 114.
  • various correction inserts 120, 121 as shown for example in the FIG. 5b and the FIG. 5c are shown used.
  • the receiving openings 111-114 have a defined square cross-section and are dimensioned so that the correction inserts 120, 121 can be introduced from the proximal side.
  • the correction inserts each comprise two lateral slide-in bodies 122, 123, 124 and 125, which are connected to one another via a support bar 126, 127.
  • the slide-in bodies 122, 123, 124 and 125, the vertical bars 126, 127 are dimensioned so that they can be pushed so far into the respective side wall in the inserted state of proximal that no shares in the proximal reference area protrude and interfere with the positive connection with the femoral surface ,
  • Each of the drawer bodies 122, 123, 124 and 125 has a pin hole 128.1 - 128.4.
  • the correction inserts are designed such that they do not resemble those in FIGS. 5b and 5c shown inserts 120, 121 inserted from the proximal into the corresponding receiving openings, but from the other side of the wall forth.
  • the inserts have this on the back Shaping and / or adhesion means, so that these correction inserts are detachably fastened to the block part.
  • the advantage of this embodiment is that the correction inserts can be easily replaced, even if the block part is attached to the femur.
  • a correction insert 130 is shown according to a further preferred embodiment, in which the position of the two pin bores 131 and 132 is changeable in the correction insert in the x and y directions.
  • the pin bores 131 and 132 are each arranged on a support plate 133, 134 displaceably mounted within the correction insert, which can be brought into a desired xy position by means of the adjusting devices 135 and in accordance with the abovementioned correction values varus / valgus, distal / proximal respectively Inside / outside rotation, anterior / posterior can be adjusted.
  • the Indian FIG. 5d In turn, correction insert 130, as shown in FIG FIGS.
  • FIG. 6a is a total knee prosthesis comprising a femur implant FI and a tibial implant TI shown in a view of Ventral in the quasi-diffracted state.
  • the same total knee prosthesis is shown in a lateral view.
  • the total knee prosthesis to be used is selected as part of the surgical planning suitable for the patient.
  • two important levels for operation planning those of the Prosthesis are given, shown in dashed lines. These are the plane for the tibial cut TS and the plane for the posterior femoral cut FSP. In the figure, the distance shown between these two levels, for example, 18mm, which corresponds to the height AU of the selected total knee prosthesis.
  • this build-up height can be simulated in the bent state and the build-up height in the stretched state after the tibial cut is performed by the patient-specific trial replacement blocks, since the respective dorsal or distal side wall is dimensioned in the thickness such that it in relation to the respective dorsal or distal femoral cut, the planned build-up height dictates, so that the femur already comes to rest in the patient-specific planned positions during the trial reduction.
  • These positions can be extremely easily checked with respect to the correct axis alignments, rotations and angular positions and especially with regard to the correct soft tissue tension and correct if necessary. This already after performing the tibial cut, without any invasion of the femur, that is, without having been cut or drilled on the femur.
  • sample reduction block 1 does not have an integrated cutting guide, but instead serves to be able to set the pins for a conventional cutting block exactly defined by means of pin bores. formed, but of a spacer 30 which lies between the dorsal side wall 5 "and the protective plate 80.
  • the wall thickness of the dorsal side wall 5" is reduced by the thickness of the spacer 30 according to the illustrated embodiment.
  • the dividing line between the two block parts according to the present invention is preferably selected such that, after removal of the anterior block part, the patella, together with the patellar eye, can be inserted undisturbed.
  • the posterior block part does not touch the patella when inserted.
  • Form-fitting means 60, 61 are shown, which serve for the correct positioning of the anterior Bolckteils 2 "and the posterior block part 3" to each other.
  • the interlocking means are formed in the region of the parting plane of the two block parts as two laterally projecting ribs 60, 61 on the posterior block part 3 ", which engage in two corresponding grooves 60, 61 in the anterior block part 2".
  • FIG. 7 is in analogy to FIG. 6 the relationship between the dimensioning of the inventive patient-specific sample reduction block 1 ", especially its distal side wall and the previously created surgical planning and the implant to be used again clarified.
  • the total knee prosthesis P comprising the femur implant FI and the tibial implant TI in a view from the ventral is now shown in a quasi-stretched state.
  • the same total knee prosthesis P is shown in a lateral view.
  • the tibial cutting planes TS which are important for surgical planning, are shown in dashed lines.
  • another plane predetermined by the prosthesis P is highly relevant, namely the plane for the distal femoral cut FSD.
  • the distal reference surface 8 is not formed directly from the distal side wall of the anterior block member 2", but from a distal side wall of a spacer in the form of a knee analyzer 31, as known in the art.
  • the wall thickness of the distal side wall is reduced by the thickness of the knee analyzer 31.
  • the sum of the wall thickness of the distal side wall of the anterior block part 2 ", the thickness of the spacer 31 and the mudguard 80 corresponds exactly to the width of the extension gap SB between the tibial cut and the distal femoral cut FSD, as provided in the surgical planning.
  • a cutting guide 90 for guiding a cutting tool for creating the distal femoral cut is arranged exactly in the plane of the distal femoral cut FSD,

Claims (14)

  1. Bloc (1, 1', 1", 100) de repositionnement de sonde servant à définir au moins un plan de coupe sur un fémur F lors d'une arthroplastie totale du genou, comprenant :
    au moins une partie proximale de référence (10) spécifique au patient, placée contre la surface distale du fémur F,
    une paroi latérale distale (4, 4', 4") et/ou au moins une paroi latérale dorsale (5, 5', 5")
    caractérisé en ce que
    la paroi latérale distale (4, 4', 4") définit une surface distale de référence (8, 8', 8") qui dans la planification opératoire spécifique au patient coïncide avec la coupe de tibia TS lors de l'extension de l'articulation du genou et/ou
    en ce que la paroi latérale dorsale (5, 5', 5") définit une surface dorsale de référence (9, 9', 9'') qui dans la planification opératoire spécifique au patient coïncide avec la coupe de tibia TS lors de la flexion de l'articulation du genou,
    l'épaisseur de la paroi latérale distale (4, 4', 4") et/ou de la paroi latérale dorsale (5, 5', 5") étant adaptée individuellement au patient ou à la planification opératoire spécifique au patient.
  2. Bloc (1) de repositionnement de sonde selon la revendication 1, caractérisé en ce que la surface distale de référence et/ou la surface dorsale de référence sont formées directement par la surface de la paroi latérale concernée.
  3. Bloc (1) de repositionnement de sonde selon la revendication 1, caractérisé en ce que la surface distale de référence et/ou la surface dorsale de référence sont formées par des écarteurs (30) disposés sur les parois latérales, les écarteurs (30) pouvant être fixés de préférence de manière libérable sur les parois latérales.
  4. Bloc (1) de repositionnement de sonde selon l'une des revendications 1 à 3, caractérisé en ce que le bloc de repositionnement de sonde comporte une partie antérieure (2) et une partie dorsale (3) de bloc qui peuvent être fixées et positionnées l'une par rapport à l'autre de manière libérable.
  5. Bloc (1) de repositionnement de sonde selon la revendication 4, caractérisé en ce que la partie antérieure de bloc (2) comporte un guide de coupe d'une coupe distale de fémur FSD ou des moyens de positionnement d'un bloc de coupe d'au moins une coupe distale de fémur FSD, le guide de coupe ou les moyens de positionnement définissant un plan de référence de la coupe distale de fémur FSD orienté par rapport au plan distal de référence du bloc de repositionnement de sonde de telle sorte que ces deux plans correspondent à l'interstice d'extension de la planification opératoire spécifique au patient.
  6. Bloc (1) de repositionnement de sonde selon la revendication 5, caractérisé en ce que la paroi latérale antérieure est dotée de moyens de positionnement de correction qui présentent de façon particulièrement préférable la forme de paires de trous et de goujons de correction ou de garnitures de correction pour pouvoir si nécessaire distaliser, proximaliser, variser ou valgiser le guide de coupe de la première coupe distale de fémur FSD.
  7. Bloc (1) de repositionnement de sonde selon la revendication 6, caractérisé en ce que les moyens de positionnement sont prévus pour les positions de correction suivantes : +1, +2, +3, +4, 0, -1, -2, -3, - 4; 1°, 2°, 3°, 4° varus/valgus autour d'un bloc de coupe distal classique ou un guide de coupe dans le bloc de repositionnement de sonde, si nécessaire pour pouvoir distaliser, proximaliser, variser ou valgiser.
  8. Bloc (1) de repositionnement de sonde selon l'une des revendications 5 à 7, caractérisé en ce que la partie distale de bloc est dotée de moyens de positionnement qui présentent de préférence la forme de paires de trous et goujons pour un bloc de coupe ou un guide de coupe d'une coupe dorsale de fémur FSB et d'une coupe antérieure de fémur FSA qui permet de guider un guide de coupe ou outil de coupe en vue d'établir la coupe dorsale de fémur FSB et la coupe antérieure de fémur FSA, les moyens de positionnement définissant la position du guide de coupe qui elle-même définit un plan de référence de la coupe de fémur qui est orienté par rapport au plan dorsal de référence (9") du bloc de repositionnement de sonde de telle sorte que ces deux plans correspondent à l'interstice de flexion de la planification opératoire spécifique au patient.
  9. Bloc (1) de repositionnement de sonde selon la revendication 8, caractérisé en ce que des moyens de positionnement de correction sont prévus pour les positions de correction suivantes : 0°-7° en rotation intérieure et extérieure par pas de 1° et +/- 1-4 mm de dérive antérieure/postérieure.
  10. Bloc (1) de repositionnement de sonde selon l'une des revendications 5 à 9, caractérisé en ce que la partie antérieure de bloc (2) comporte un guide de coupe pour une coupe antérieure de fémur FSA et/ou une coupe postérieure de fémur FSB et/ou d'autres coupes de fémur.
  11. Bloc (1) de repositionnement de sonde selon l'une des revendications 4 à 10, caractérisé en ce que la partie dorsale de bloc (3) est dotée sur la paroi dorsale latérale (5) et la partie antérieure de bloc (2) sur la paroi latérale distale (4) de découpes de réception de capteurs et/ou de capteurs.
  12. Bloc (1, 100) selon l'une des revendications précédentes, caractérisé en ce qu'au moins la partie proximale de référence (10) spécifique au patient et de préférence les parois latérales dorsales et les parois latérales distales (3, 4) des parties dorsales et antérieures de bloc sont réalisées par une opération de prototypage rapide.
  13. Bloc (1, 100) selon l'une des revendications précédentes, caractérisé en ce que les parties dorsales de bloc peuvent être reliées de manière libérable l'une et l'autre par des moyens de correspondance géométrique et/ou de correspondance mécanique (12, 60, 61) et peuvent être placées les unes par rapport aux autres en des positions relatives définies.
  14. Procédé de fabrication d'un bloc (1, 1', 1'', 100) de repositionnement de sonde spécifique au patient en vue de définir au moins un plan de coupe sur un fémur F lors d'une arthroplastie totale du genou, dans lequel
    au moins une partie proximale de référence (10) spécifique au patient placée contre la surface distale du fémur F est réalisée sur la base de données 3D du genou à traiter,
    caractérisé en ce que
    une paroi latérale distale (4, 4', 4") est réalisée de manière à définir une surface distale de référence (8, 8', 8") qui dans la planification opératoire spécifique au patient coïncide avec la coupe de tibia (TS) lors de l'extension de l'articulation du genou et/ou
    en ce qu'une paroi latérale dorsale (5, 5', 5") est réalisée et définit une surface dorsale de référence (9, 9', 9") qui dans la planification opératoire spécifique du patient coïncide avec la coupe de tibia TS lors de la flexion de l'articulation du genou,
    l'épaisseur de la paroi latérale distale (4, 4', 4") et/ou de la paroi latérale dorsale (5, 5', 5'') étant adaptée individuellement au patient ou à la planification opératoire spécifique au patient.
EP12705125.8A 2011-02-21 2012-02-17 Bloc de réduction d'essai spécifique au patient Active EP2677939B1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
CH00301/11A CH704563B1 (de) 2011-02-21 2011-02-21 Patientenspezifischer Proberepositionsblock.
PCT/EP2012/052814 WO2012113735A1 (fr) 2011-02-21 2012-02-17 Bloc de réduction d'essai spécifique au patient

Publications (2)

Publication Number Publication Date
EP2677939A1 EP2677939A1 (fr) 2014-01-01
EP2677939B1 true EP2677939B1 (fr) 2015-07-15

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EP12705125.8A Active EP2677939B1 (fr) 2011-02-21 2012-02-17 Bloc de réduction d'essai spécifique au patient

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US (1) US10624654B2 (fr)
EP (1) EP2677939B1 (fr)
JP (1) JP5939544B2 (fr)
CN (1) CN103491882B (fr)
CH (1) CH704563B1 (fr)
WO (1) WO2012113735A1 (fr)

Families Citing this family (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN104968301B (zh) * 2013-02-07 2017-03-22 捷迈有限公司 锥形胫骨扩增件
WO2015027287A1 (fr) * 2013-09-02 2015-03-05 The Australian On-Line Prosthetic Company Cales personnalisées pour évaluer un alignement et une stabilité préplanifiés et pour aider à l'alignement des éléments dans une arthroplastie totale du genou
GB2544102A (en) * 2015-11-06 2017-05-10 Matortho Ltd Tool
SG11201909725PA (en) * 2017-05-23 2019-11-28 Manish Shah A jig for guiding placement of femoral component of the implant in knee replacement surgery
KR102105910B1 (ko) * 2017-06-23 2020-04-29 전남대학교 산학협력단 자석 배열을 이용한 치료제 표적화 및 고정 의료장치
US10856891B2 (en) 2018-05-29 2020-12-08 DePuy Synthes Products, Inc. Customized patient-specific orthopaedic surgical instruments

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Publication number Priority date Publication date Assignee Title
US4938762A (en) 1987-12-16 1990-07-03 Protek Ag Reference system for implantation of condylar total knee prostheses
FR2713916B1 (fr) * 1993-12-20 1996-02-09 Gilles Voydeville Guide de coupe fémorale.
SE9304261D0 (sv) 1993-12-22 1993-12-22 Radi Medical Systems Anordning för biopsiprovtagning
WO1997030648A1 (fr) * 1996-02-23 1997-08-28 Midwest Orthopedic Research Foundation Dispositif et procede pour le decoupage de l'extremite distale du femur et la mesure d'une prothese
US6488687B1 (en) * 1997-09-18 2002-12-03 Medidea, Llc Joint replacement method and apparatus
CN1245928C (zh) * 1998-06-29 2006-03-22 内用假肢股份公司 植入膝假体的设备
US8439926B2 (en) * 2001-05-25 2013-05-14 Conformis, Inc. Patient selectable joint arthroplasty devices and surgical tools
US7442196B2 (en) * 2004-02-06 2008-10-28 Synvasive Technology, Inc. Dynamic knee balancer
EP2478874B1 (fr) * 2006-03-21 2014-05-28 DePuy (Ireland) Prothèse d'arthroplastie totale à moments induits
US8038681B2 (en) * 2007-09-30 2011-10-18 Depuy Products, Inc. Modular femoral orthopaedic surgical instrument
US8398645B2 (en) * 2007-09-30 2013-03-19 DePuy Synthes Products, LLC Femoral tibial customized patient-specific orthopaedic surgical instrumentation
US9017334B2 (en) * 2009-02-24 2015-04-28 Microport Orthopedics Holdings Inc. Patient specific surgical guide locator and mount

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Publication number Publication date
CH704563B1 (de) 2015-04-30
JP2014513566A (ja) 2014-06-05
JP5939544B2 (ja) 2016-06-22
CN103491882B (zh) 2016-04-20
US10624654B2 (en) 2020-04-21
EP2677939A1 (fr) 2014-01-01
WO2012113735A1 (fr) 2012-08-30
US20140052136A1 (en) 2014-02-20
CN103491882A (zh) 2014-01-01
CH704563A2 (de) 2012-08-31

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